Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

The Paleocene Hangu formation : a key to unlocking the mysteries of Paleo-Tethys tectonism

DATA AVAILABILITY : Data will be made available on request.The sedimentary rocks of the Paleocene Hangu Formation in the Yadgaar Section of the Upper Indus Basin in northern Pakistan, have been the subject of an integrated field, petrographical, and sedimentological investigation. The goals of this study are to improve our understanding of the sedimentary environment, facies shifts, and the impact of tectonism on the genesis of the investigated sedimentary facies. A better understanding of the intricate relationships between the aforementioned factors will clarify whether the regional tectonic drive has partial control over or complete command of the sedimentation processes. The results of this study shows that the Hangu Formation consists of four facies: bauxite, sandstone, coal, and limestone. The bauxite deposits formed in a karst environment with severe chemical weathering in a humid to extremely humid climatic setting. Thin coal laminae indicate a peatland environment that formed within a humid tropical climate. Sub-arkose, arenite, and arkose sandstone facies mark deltaic (sub-humid), coastal–near shore (humid to hot-humid), and high-energy fluvial (arid to semi-arid) sedimentary environments, respectively. Finally, the occurrence of marly limestone points towards deposition on a shallow marine carbonate platform within a coastal-brackish environment. The facies shift of the sediments provides evidence for a gradual transition from continental to marine conditions within the study area, together with episodic transgressive and regressive cycles as well as changing climatic and geomorphological conditions. In consequence, all these changes are controlled and shaped by the effects of Paleo-Tethys tectonism during the Indo-Eurasian intra-oceanic subduction. This advancement through the current work helps in understanding tectonic-sedimentary mechanics, i.e., how regional tectono-sedimentological processes influence the formation of sedimentary sequences.The China-ASEAN Maritime Cooperation Fund Project and the National Natural Science Foundation of China.https://www.elsevier.com/locate/marpetgeo2024-09-22hj2023Geolog

Green Technology Innovation, Globalization, and CO₂ Emissions: Recent Insights from the OBOR Economies

This study explores the connection between technological innovation, globalization, and CO2 emissions by controlling the critical influence of information and communication technology (ICT) and economic growth in a panel of One Belt One Road (OBOR) countries from 1991 to 2019, utilizing advanced and robust econometric strategies (second generation). In addition, this study also uses an interaction variable (TI*GLOB) to check the interaction role of technological innovation on the linkage between globalization and CO2 emission, besides their direct effect on CO2 emissions in OBOR countries. The outcomes revealed that the linkage between technological innovation and CO2 emissions is negative, and statically significant in all the regions (e.g., OBOR, South Asia, East and Southeast Asia, MENA, Europe, and Central Asia). Moreover, the results of globalization show a significant positive relationship with CO2 emissions in OBOR and South Asia region. Nevertheless, it significantly negatively affects environmental pollution in East and Southeast Asia, MENA, Europe, and Central Asia. The results of TI*GLOB indicate that, for the OBOR sample, East and Southeast Asia, and Central Asia, the moderation effects of technological innovation with globalization are significantly negatively associated with CO2 emissions. However, in MENA and Europe, the interaction effect is a significant positive. The coefficient of ICT for OBOR, Europe, and Central Asia are positive and statistically significant; however, for East, Southeast Asia, and MENA regions, these results are statistically negative. Furthermore, the findings are robust, according to various robustness checks that we have performed for checking the reliability of our main findings. The study establishes numerous polities and makes various recommendations, in light of relevant conclusions

Green growth as a determinant of ecological footprint: Do ICT diffusion, environmental innovation, and natural resources matter?

The nexus between green growth and ecological footprint is associated with crucial environmental implications. But this domain is not examined sufficiently and provides ambiguous findings. Furthermore, these studies have not addressed the role of natural resources, environmental innovation, and ICT in influencing ecological footprint. Our study analyzes the impact of green growth, ICT, environmental innovation, and natural resources on the ecological footprint ofemerging-7 and developed-7 economies. We employed CS-ARDL methodology to draw the long-run and short-run estimates of the said relationships. The obtained findings show that green growth, ICT, and environmental innovation reduce the ecological footprint in emerging economies in the long run. However, natural resources enhance the ecological footprint in emerging economies in the long run. Green growth, ICT, natural resources, and environmental innovation reduce the ecological footprint in the long run in developed economies. Based on these outcomes, the study recommends important policy suggestions

Modeling, Quantifying and Visualizing Media Bias on Twitter

News media garner a lot of attention regarding the subjectivity of their reporting. News media bias is of immense interest to various individuals, as the systematic preference of an entity can invoke its support and public actions. These inclinations, although apparent, hinder the true facts. The identification and quantification of media bias is one of the most important metrics in reference to bias assessment in media and general public. In this paper, we present a principled approach to quantify media bias along with insightful visualizations for popular media sources using their tweets. We use the concept of a mini-world of N $\times$ M matrix to model the sources and entities of interest, where the tweet counts and respective polarities over a specified time period are the values. Direct comparisons between these two are not as meaningful due to the neglection of inherent characteristics of sources and entities. Thus, we define coverage and statement scores as properly normalized measures of tweet counts and polarity rates. Furthermore, we present a statistically consistent model of neutral tweet counts and polarity rates, using which we define the absolute coverage and statement bias of each source-entity pair. We illustrate our approach on two data sets capturing tweets on 1) Prime minister candidates of top political parties of Pakistan in the 2018 general election 2) Paris and Beirut bombings in 2015 by different news sources. The results indicate that our model is generalizable i.e. it can be applied to different entities/sources and in consistent with previous studies

Is the economic uncertainty- human health relationship nonlinear? An empirical analysis for the China.

The health costs of economic uncertainty always remain a major concern among policymakers of China. The theoretical and empirical literature on the economic uncertainty-human health nexus is still in its infancy stage. This study is firmly rooted in the economic uncertainty theory advanced by Baker, Bloom, & Davis. In this study, the primary objective of the analysis is to estimate the asymmetric impact of economic uncertainty on human health in China's economy. In order to evaluate the short and long-run estimates of economic uncertainty on human health across various quantiles, we have employed the linear and nonlinear QARDL models. The linear QARDL model shows that the long-run relationship between economic uncertainty and the infant mortality rate is positive and significant at all quantiles, while the long-run relationship between economic uncertainty and the death rate is positive and significant at higher quantiles. The nonlinear QARDL model reveals that, in the long run, the relationship between the positive shock of economic uncertainty and the infant mortality rate is positive and significant at quantiles 0.30 to 0.95, while the long-run relationship between the positive shock of economic uncertainty and the death rate is positive and significant at higher quantiles. The relationship between the negative shock of economic uncertainty and the infant mortality rate is negative and significant at the highest quantiles, while the relationship between the negative shock of economic uncertainty and death rate is negative and significant at higher quantiles in the long run. The findings indicate a positive relationship between economic uncertainty in China and higher rates of infant mortality and death. Thus, adopting suitable policies for controlling economic uncertainty can help in improving human health in China

Sedimentology and Diagenesis of the Early–Middle Eocene Carbonate Deposits of the Ceno-Tethys Ocean

An integrated study based on field observation, petrography, and scanning electron microscopy (SEM) on the Early–Middle Eocene carbonate rocks has been carried out, which were deposited in the Ceno-Tethys Ocean. The study area of the Yadgaar Section lies on the eastern margin of the Upper Indus Basin, Pakistan. The Early–Middle Eocene Margalla Hill Limestone and Chorgali Formation act as reservoir rocks in other parts of the basin and are also present in the Yadgaar Section. The lack of comprehensive study in this area makes these reservoir rocks highly attractive for sedimentological evaluations and future exploration of hydrocarbons. The Early–Middle Eocene carbonate rocks are divided into nine microfacies: dolomicritic foraminiferal mudstone–wackestone microfacies (EMI); green algae dominated, mixed foraminiferal wackestone–packstone microfacies (EMII); ostracod, green algae and gypsum dominating mudstone–wackestone microfacies (EMIII); algae and mixed foraminiferal wackestone–packstone microfacies (EMIV); Nummulites dominating mudstone–wackestone microfacies (EMV); algal limestone mudstone microfacies (EMVI); Assilina bed wackestone–packstone microfacies (EMVII); micritized larger benthic foraminiferal wackestone–packstone microfacies (EMVIII); and algal limestone, mudstone microfacies (EMIX). The transgressive-regressive environment in the Ceno-Tethys Ocean leads to the deposition of these microfacies in the platform interior, open marine platform, platform edge, platform margin reef, toe of the slope apron, arid–humid platform interior, platform edge, open marine platform interior, and restricted marine platform interior, respectively. Initial post-depositional diagenetic stages are identified from the base to the top of the strata by their respective cement types, i.e., the base–lower middle part of the strata demonstrates an eogenetic sub-stage with the appearance of drusy cement, the middle section indicates a mesogenetic sub-stage by the appearance of blocky cement, while the top portion again reveals an eogenetic sub-stage of diagenesis by the presence of drusy and blocky types of cement. The ascending–descending hierarchy of cement generations is directly proportional to the grade of diagenesis from the base to the top of the carbonate strata. Variable diagenetic effects on the various microfacies also increase the secondary porosity range and enhance the reservoir characteristics of the Formations. The presence of foraminifera microfossils determined that these carbonate formations date from the Early–Middle Eocene

An integrated petrographical and geochemical study of the Tredian Formation in the Salt and Trans‐Indus Surghar ranges, North‐West Pakistan: Implications for palaeoclimate

Abstract The Middle Triassic Tredian Formation is well exposed in the western region of the Salt Range. It is mostly composed of sandstone with minor alternations of shales and dolomite. This is the first integrated attempt using petrographical and geochemical features to reveal palaeoclimate during deposition of the Tredian Formation. This work sheds light on the petrographical and geochemical properties of the Tredian sandstone in order to date various layers and evaluate the palaeoclimate. The formation was sampled at two distinct stratigraphic layers for petrographic and geochemical analysis of major and trace elements. The sandstone of the Tredian Formation is sub‐feldspathic to feldspathic arenite with sub‐angular to rounded grains that are moderately to extensively sorted. The relative proportions of the quartz, feldspars and lithoclasts in the examined sandstone samples shows that the Tredian sediments originated from the interior of the craton during a transitional continental regime. Chemical index of alteration values of 59, chemical index of weathering values of 67, and plagioclase index of alteration values of 74.5 indicate a low to moderate degree of weathering in the Tredian sediment source region. Based on the silica content, SiO2/Al2O3 ratios (2.7–6.1; mean 4.1), and chemical maturity index, it is deduced that the Tredian Formation was deposited in chemically immature to sub‐mature and dry to semi‐arid conditions. Geochemical proxies indicate the acidic source of sediment and deposition on the passive margin of the Indian Plate. The trace element characteristics of the sediments, especially the Rb/Sr, Cu/Zn, Ni/Co, V/Cr and Sr/Ba ratios, indicate that the sediments originated from the first weathering cycle and support the notion that they were deposited in an oxidising continental environment. A semi‐arid to arid palaeoclimate predominated through the Middle Triassic at the north‐western passive continental margin of the Indian Plate in the south‐eastern Neo‐Tethys